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CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <br />Please check item or items for which you are applying: <br />Rezoning $100 <br />Special Use Permit _ _ Division of Platted Lot $50 <br />Vacation of Right -of -Way $100 Relocation of Dwelling $50 <br />Variance <br />Preliminary and Final Plat to Zoning Ordinance <br />$100 Minor Variance <br />$50 <br />Please complete form by typing or printing in ink. If the spaces <br />use additional sheets, keying information to the <br />$25 <br />are insufficient, <br />proper itemnumbersovided <br />?L 'Pe- j V <br />Name of Owner: (First.) (Middle; (Last) <br />2 • n <br />� <br />(Phone:) <br />Address of Owner: (No. and S --`U1111C /`�Y <br />treet) (City) <br />5//J� <br />(State) <br />3 . k) K-d � , LL1 Y! <br />zi <br />1 e <br />Name of Applicant: (First) (Middle) Last <br />( ) <br />/�� <br />4 . :�Cp � / I l l rI /��So f /���.. pl� <br />(Phone) <br />a) <br />Address of Applicant: (No, and Street (Cite- V111e � <br />.� _. <br />Y) (State) <br />5. �v l l� � �P <br />(Zip) <br />.�. <br />Street Address of Property Involved <br />6. Complete legal description of property involved: Lo <br />7. Date Property Acquired: Ll ` 7�7 � <br />8. Present Use of Property: S'I <br />-`— d eProposed Use of Property: <br />9. Present Zoning of Property: <br />—-P Proposed Zoning of Property: <br />10. What plan or change makes this <br />11. GAyGI.I.Cu GrrecL of the proposed change? <br />health, safet (For example, on property values, <br />y, parking, traffic conditions, etc.) <br />0 <br />